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Since its implementation in December 2016, use of a ceftolozane-tazobactam order set at Marin General Hospital has advanced antimicrobial stewardship efforts.

Integrating Order Sets Into Antimicrobial Stewardship Strategies

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

ACC Issues Vaccine Guidance for People With Heart Disease

The American College of Cardiology issued recommendations for influenza, COVID-19, RSV, and other vaccinations, emphasizing immunization as a cornerstone of cardiovascular care.

FDA Suspends Valneva’s Chikungunya Vaccine IXCHIQ License

The FDA suspended the license for IXCHIQ after 4 new serious adverse events (SAEs) were reported, halting US sales while Valneva continues investigations and global distribution.

CDC Confirms Biannual COVID-19 Peaks; ACIP Adjusts Guidance

CDC data confirmed consistent late-summer and winter COVID-19 surges. ACIP shifted to targeted recommendations, including 2 annual vaccine doses for adults 65 years or older.

HHS Reinstates Childhood Vaccine Safety Task Force

HHS revived the federal task force on vaccine safety after 27 years, amid rising exemption rates and parental hesitancy.

FDA Lifts Pause on IXCHIQ Use in Adults 60+

After review, the FDA allowed the resumed use of IXCHIQ in adults 60 years or older, adding updated prescribing warnings about SAE risk in older adults with comorbidities.

Rising COVID-19 Cases Spark Concern Over Narrow Booster Access

Experts warned of a late-summer surge due to low vaccine uptake (23% of adults, 16% of children) and booster restrictions that limited broader protection.

HHS Approves Removal of Thimerosal From Flu Vaccines

Following ACIP’s recommendation, thimerosal is being removed from influenza vaccines, with officials aiming to strengthen parental confidence in vaccine safety.

COVID-19 Boosters Cut Hospitalizations in People With Cancer

A large US study showed booster vaccination significantly reduced hospitalization risk in adults undergoing chemotherapy or immunotherapy.

FDA Approves Prefilled Syringe Format for Shingrix

The new format for GSK’s shingles vaccine eliminates reconstitution, simplifying administration and supporting broader uptake among older adults.

Danish Study Reinforces Aluminum Vaccine Safety

Research found no association between aluminum adjuvants in childhood vaccines and autism, asthma, or other health outcomes, reinforcing their safety profile.

FDA Authorizes Moderna COVID-19 Vaccine for Children 6 Months–11 Years

Moderna’s updated Spikevax will be available for children younger than 12 years for the upcoming respiratory virus season.

Monoclonal Antibody Shows Strong COVID-19 Prevention Efficacy

Invivyd’s pemivibart (Pemgarda) demonstrated 84% relative risk reduction of symptomatic COVID-19 vs placebo in phase 3 trials.

ACIP June 2025 Meeting: Targeted Vaccination Strategy Adopted

ACIP endorsed a shift away from universal vaccination toward population-specific recommendations, with 2 annual doses recommended for adults 65 years or older.

From chikungunya setbacks to COVID-19 booster guidance and childhood vaccine safety initiatives, here are the top regulatory and research developments this summer.

Summer 2025 Vaccine News Roundup: FDA, CDC, and HHS Updates

A 9-month pilot study in 3 nursing homes found that routine chlorhexidine bathing and nasal iodophor use reduced multidrug-resistant organism (MDRO) colonization among residents by 55%, but did not significantly affect environmental contamination in rooms of MDRO carriers.

Researchers analyzed outcomes across a baseline, phase-in, and intervention period. Colonization rates decreased from 46% (411/900) at baseline to 29% (262/900) during the intervention (OR, .45; 

 < .001). Significant reductions were observed in colonization with methicillin-resistant 

 (VRE), and extended-spectrum beta-lactamase producers (ESBL) (

Despite these reductions, environmental contamination remained high in rooms of residents who continued to carry MDROs. Of 330 colonized residents, 288 rooms (87%) had at least 1 high-touch object contaminated with an MDRO. Multivariable analysis found that contamination was associated with antibiotic use (OR, 1.54; 95% CI, 1.19-1.98), presence of wounds (OR, 1.34; 95% CI, 1.02-1.77), and certain fomites such as bedside tables and bedrails (OR, 12.7; 95% CI, 9.37-17.25). The intervention period itself was not significantly associated with changes in contamination (OR, 1.02; 95% CI, .81-1.27).

The investigators concluded that while decolonization strategies effectively reduce resident-level MDRO burden, additional measures targeting environmental cleaning in rooms of MDRO carriers are necessary to curb transmission risk.

Findings from another setting echo these challenges. A study reported by 

 exposure in dialysis centers across 4 US states. Standard infection prevention and control (IPC) practices, including bleach disinfection, routine use of PPE, and short patient stays, were sufficient to prevent new transmissions, even when facilities were unaware of colonization status. Communication gaps between health care settings delayed containment.

Together, these studies highlight the complexity of MDRO control in congregate care. Nursing homes demonstrated that colonization can be reduced, though environmental reservoirs persist. Dialysis centers showed that robust baseline IPC can block transmission despite colonization, but information sharing between facilities remains a critical weakness. Effective MDRO containment will require both strong routine IPC and improved cross-setting communication.

1.Flores EA, Singh R, McKinnell JA, et al. Impact of routine chlorhexidine bathing and nasal iodophor on MDRO colonization and environmental contamination in nursing homes. Infection Control & Hospital Epidemiology. Published online 2025:1-7. doi:10.1017/ice.2025.10234

2.Kurutz A, Innes GK, Sherman A, et al. Candida auris Containment Responses in Health Care Facilities that Provide Hemodialysis Services — New Jersey, North Carolina, South Carolina, and Tennessee, 2020–2023. MMWR Morb Mortal Wkly Rep 2025;74:415–421. DOI: 

A 9-month pilot study showed a 55% reduction in resident colonization with MRSA, VRE, and ESBL, but contamination of high-touch surfaces persisted in rooms of MDRO carriers.

Routine Decolonization Cuts MDRO Burden in Nursing Homes but Leaves Environmental Risks

The US Food and Drug Administration (FDA) has suspended the license for Valneva’s chikungunya vaccine IXCHIQ, effective immediately, after updated safety monitoring identified 4 new reports of serious adverse events (SAEs) consistent with chikungunya-like illness. The suspension requires Valneva to stop shipping and selling IXCHIQ in the US, the company announced on August 25, 2025.

The decision follows the FDA’s earlier August 6 action lifting a temporary pause on use of IXCHIQ in individuals 60 years or older, after a prior review of SAEs had concluded the benefits of vaccination outweighed risks in older adults with comorbidities. New VAERS data included 4 additional SAEs, all reported outside the US; 3 cases occurred in adults aged 70 to 82 years, including 1 hospitalization with recovery after 2 days, and 1 case in a 55-year-old.

Valneva stated that the clinical presentation of these cases was consistent with events observed in prior clinical trials and postmarketing reports, especially among older vaccine recipients, for whom the prescribing information includes warnings and precautions. The company reported IXCHIQ generated €7.5 million in sales during the first half of 2025, out of €91 million total product sales, largely from one-time deliveries to address an outbreak in La Réunion.

CEO Thomas Lingelbach emphasized that despite the suspension, Valneva remains committed to maintaining vaccine access in countries where IXCHIQ is licensed and to accelerating distribution in low- and middle-income endemic regions. The company is continuing to investigate the new SAE reports and may pursue further regulatory steps under FDA procedures. Valneva is also assessing the potential financial impact of a permanent withdrawal of the US license, but has not changed its 2025 revenue guidance.

Timeline: FDA Actions on Valneva’s Chikungunya Vaccine IXCHIQ

 Following a 3-month safety review in collaboration with the European Medicines Agency, the FDA lifted its pause on IXCHIQ use in adults 60 years or older. Updated labeling added warnings about SAE risks in older adults with chronic conditions. IXCHIQ remained indicated for high-risk adults 18 years or older, whereas use in low-risk US travelers and immunocompromised individuals was discouraged.

The FDA and CDC recommended pausing IXCHIQ use in adults 65 years or older after reports of SAEs, including 1 fatality, during a vaccination campaign in La Réunion. The precaution was based on VAERS reports, though no causal link was established.

 The Advisory Committee on Immunization Practices (ACIP) recommended chikungunya vaccination for travelers to outbreak regions and laboratory workers at risk. During the meeting, ACIP reviewed safety data from IXCHIQ trials, noting 6 serious adverse events (SAEs) and highlighting challenges in assessing reactions in older adults with comorbidities.

1.Valneva. Valneva Announces FDA’s Decision to Suspend License of Chikungunya Vaccine IXCHIQ® In the U.S. August 25, 2025. Accessed August 25, 2025. 

https://valneva.com/press-release/valneva-announces-fdas-decision-to-suspend-license-of-chikungunya-vaccine-ixchiq-in-the-u-s/

2.Valneva Announces Removal of FDA-Recommended Pause on Use of Chikungunya Vaccine IXCHIQ® in Elderly and Updates to the Prescribing Information. August 7, 2025. Accessed August 25, 2025. 

https://www.globenewswire.com/news-release/2025/08/07/3128880/0/en/Valneva-Announces-Removal-of-FDA-Recommended-Pause-on-Use-of-Chikungunya-Vaccine-IXCHIQ-in-Elderly-and-Updates-to-the-Prescribing-Information.html

3.Valneva. Valneva Provides Update on Recommended Use of IXCHIQ® by Elderly Individuals in the United States. GlobalNewswire. May 12, 2025. Accessed August 25, 2025. 

https://www.globenewswire.com/news-release/2025/05/12/3078777/0/en/Valneva-Provides-Update-on-Recommended-Use-of-IXCHIQ-by-Elderly-Individuals-in-the-United-States.html

4.Abene S. CDC ACIP Meeting Examines Next Steps for Meningococcal, RSV, and Chikungunya Vaccination. Contagion. April 16, 2025. Accessed August 25, 2025. 

https://www.contagionlive.com/view/cdc-acip-meeting-examines-next-steps-for-meningococcal-rsv-and-chikungunya-vaccination

Regulators cite four new serious adverse event reports, halting US distribution while global access efforts continue.

FDA Suspends US License for Valneva’s Chikungunya Vaccine IXCHIQ

Leaders from the UNC Special Pathogens Response Center (SPARC) discuss how they plan and carry out biopreparedness trainings to address any serious individual episodes of highly infectious patients as well as addressing larger outbreaks.  

Biopreparedness Exercises Look to Address Highly Contagious Disease Outbreaks

We are continuing our new series, Media Day, spotlighting individual medical institutions and infectious disease (ID) programs. Today, we spotlight UNC’s Institute for Global Health and Infectious Diseases (IGHID).

The University of North Carolina’s Special Pathogens Response Center is one of 13 centers across the US responsible for building regional preparedness. This means these special centers interact and coordinate training with other health care facilities, like local and regional hospitals, to aid them in dealing with individuals with high-consequence infectious disease (HCID).

“While there is not a standardized definition for [HCIDs] or special pathogens, expert consensus defines these as novel or reemerging infectious agents that are easily transmitted from person-to-person, have limited or no medical countermeasures (such as an effective vaccine or prophylaxis), have a high mortality, require prompt identification and implementation of infection control activities (for example, isolation, special personal protective equipment), and require rapid notification to public health authorities and special action," said UNC Director of Emerging Pathogens Institute for Global Health and Infectious Diseases William Fischer II, MD.

Examples of this would be Ebola virus, severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), as well as others.

“We lead regional trainings to better prepare other health care facilities, because we're trying to make sure that anywhere a patient can present, they are prepared to identify, and initiate safe delivery of care, and then transfer that individual to a regional treatment center,” Fischer said.

Part of the training is to ensure any necessary quarantining of individuals is done in a way that minimizes the risk to the greater public. To prepare for big events such as the FIFA World Cup in the US next year, national readiness exercises have been conducted this summer for HCID threats.

 These exercises have been named Tranquil Passport and are led by the US Department of Health and Human Services’ Administration for Strategic Preparedness and Response. Specifically, they tested a coordinated national response to an HCID scenario.

In June, UNC's Medical Center Special Pathogens Response Center (SPARC) team conducted a test for a high-consequence infectious disease patient using a mannequin. This training exercise focused on "interdisciplinary coordination among pediatric specialists, infectious disease experts, and transport teams. The simulation also included a mock surgical procedure within the biocontainment unit, allowing the team to exercise infection control, communication, and clinical workflows required to safely perform emergency interventions in a high-risk environment."

"The country is in much better shape right now than they were from before we did this exercise, because now a lot of us in this country now know how to handle this much better," said David Wohl, MD, professor of medicine in the Division of Infectious Diseases, UNC.

As individuals with HCID won’t know about these special pathogen centers, these trainings between the centers and the regional hospitals are critical, explains Wohl.

“We really have to prepare this network of regional hospitals,” Wohl said. “One thing that's really important to understand is infectious diseases that are emerging and reemerging are becoming much more common and frequent—and they're becoming bigger in scope.”

He references the West Africa Ebola outbreak of 2014 to 2016 that infected over 28,000 people with the deadly disease.

 Wohl says this is massive compared with previous large outbreaks, which were thought of in terms of 100 to 200 people being infected. 

As part of their experience, both Fischer and Wohl have been in hot zones in Africa treating patients who have had Ebola and Lassa fever. They have set up field treatment units during outbreak settings to isolate and care for patients. Their work in Liberia has directly informed emerging pathogen response and preparedness in North Carolina.

 will cover their work in Africa in a future episode.)

Although Ebola has not had an impact in the US, Wohl uses mpox as an example that has seen outbreaks in the US in recent years. 

Fischer says the concept of specialized medical centers is not a new one.

“These centers of specialization…they parallel what's been done for trauma; They parallel what's been done for sepsis—what's been done for ARDS [Acute Respiratory Distress Syndrome],” Fischer said. “If you can develop expertise at specific centers and then educate and increase awareness among all providers, we can then identify individuals that might have a special pathogen, get them to the center of specialty where that specialized care can be provided, and we know that model works.”

In the next episode, Ben Smith, MD, discusses logistical and safety challenges in preparing for the transport of infectious patients from outside facilities to UNC.

References
1.What are the key points to understand when defining processes that support preparedness for high-consequence infectious diseases or special pathogens? Joint Commission. Accessed August 27, 2025. 
https://www.jointcommission.org/en-us/knowledge-library/support-center/standards-interpretation/standards-faqs/000002503
2.Tranquil Passport: Testing the Nation’s Special Pathogen Readiness Ahead of the FIFA World Cup. NETEC. July 2, 2025. Accessed August 26, 2025. 
https://netec.org/2025/07/02/tranquil-passport-testing-the-nations-special-pathogen-readiness-ahead-of-the-fifa-world-cup/
3.Ebola Outbreak 2014-2016. WHO. Accessed August 26, 2025. https://www.who.int/emergencies/situations/ebola-outbreak-2014-2016-West-Africa

Leaders from the UNC Special Pathogens Response Center discuss how they plan and carry out biopreparedness trainings to address transport and care of patients with high-consequence infectious diseases, such as Ebola or Lassa fever.   

Biopreparedness Exercises Look to Contain High-Consequence Infectious Disease Outbreaks

Deeksha Jandhyala, MD, discusses how she and her team work to prevent infections and provide clinical assistance  

Supporting the AHN Transplant Program

We are continuing our new series, Media Day, where we spotlight individual medical institutions and infectious disease (ID) programs. Today, we spotlight the Allegheny Health Network (AHN) in Pittsburgh, Pennsylvania.

Allegheny General Hospital in Pittsburgh, Pennsylvania, the flagship hospital within the Allegheny Health Network (AHN), has a storied history within surgery, especially as it relates to heart procedures.

One of its physicians, George Magovern, MD, was a pioneer in surgical techniques including open-heart procedures. Magovern partnered with Edward Kent, MD, a nationally recognized chest surgeon, introduced to the area the very first open-heart procedures using the heart-lung machine.

Magovern also partnered with a local engineer, Harry Cromie, to develop a revolutionary sutureless prosthetic aortic valve designed to shorten operative times and improve patient outcomes. This led to greater survival rates for these procedures.

In 1963, Magovern performed the world’s second left single lung transplant in a man dying of emphysema.

 Today, AHN continues to offer an array of different transplants including heart, liver, kidney, pancreas, stem cell/chimeric antigen receptor T-cell transplants, and left ventricular assist device procedures.

Deeksha Jandhyala, MD, an infectious diseases (ID) specialist with the AHN Medicine Institute and medical director of transplant infectious diseases at Allegheny General Hospital, noted that the transplant department recently reached a milestone of performing its 500th heart transplant.

Behind the scenes, there is much to consider before transplant candidates are approved for such procedures. One of these significant steps is when Jandhyala and her team screen them for infections. They support their transplant program by seeing transplant candidates through the surgical cycle. They treat a broad array of diseases caused by microorganisms and manage infectious diseases in patients pre- and post transplant.

Deeksha Jandhyala, MD, discusses how her team works to prevent infections and provide clinical assistance for transplant candidates.  

Alexander R. Evens, DO

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